基于CTA探究冠周脂肪体积、FAI、PCATMA与冠心病患者冠脉狭窄、斑块性质及预后关系

Exploration on the Relationship between Pericoronal Fat Volume,FAI,PCATMA and Coronary Stenosis,Plaque Properties,Prognosis in Patients with Coronary Heart Disease Based on CTA

目的基于计算机断层扫描血管成像(CTA)探究测量冠周脂肪体积、冠周脂肪衰减指数(FAI)、冠周脂肪平均衰减(PCATMA)与冠心病冠脉狭窄、斑块性质及预后关系。方法选取2020年9月至2022年12月来院就诊的冠心病患者121例,所有患者均行CTA检查,测定冠周脂肪体积、FAI、PCATMA。根据冠脉狭窄程度将患者分为中度组和重度组,根据斑块性质分为非钙化组、钙化组和混合组;同时展开1年随访,根据是否发生主要不良心脏事件(MACE)分为MACE组和非MACE组。对比各亚组冠周脂肪参数水平,采用多因素Logistic回归分析冠心病患者发生MACE的影响因素,并绘制受试者工作特征(ROC)曲线评价其对患者MACE的预测价值。结果重度组冠周脂肪体积、PCATMA低于中度组,FAI高于中度组(P<0.05)。不同斑块性质患者冠周脂肪参数的比较,差异有统计学意义(P<0.05);其中钙化组冠周脂肪体积高于混合组,PCATMA高于非钙化组、混合组,FAI低于非钙化组、混合组(P<0.05)。MACE组病变血管两支及以上、冠脉重度狭窄占比、FAI高于非MACE组,PCATMA低于非MACE组(P<0.05)。多因素Logistic分析显示,冠脉重度狭窄、高FAI值是患者随访1年发生MACE的独立危险因素(P<0.05)。FAI和PCATMA单独应用预测AUC分别为0.736(0.634~0.838)、0.673(0.572~0.774),联合应用AUC为0.857(0.785~0.930),高于上述指标单独应用(P<0.05)。结论不同冠脉狭窄程度和斑块性质的冠心病患者表现出不同的冠周脂肪CTA特征,冠脉重度狭窄、高FAI值是患者随访1年发生MACE的独立危险因素,联合FAI和PCATMA对患者MACE发生有较高的预测价值。

Objective To explore the relationship between pericoronal fat volume,fat attenuation index(FAI),fat average attenuation(PCATMA)and coronary stenosis,plaque properties,prognosis in patients with coronary heart disease(CHD)based on computed tomography angiography(CTA).Methods A total of 121 patients with CHD treated in the hospital were enrolled between September 2020 and December 2022.All underwent CTA to measure pericoronal fat volume,FAI and PCATMA.According to severity of coronary stenosis,patients were divided into moderate group and severe group.According to plaque properties,patients were divided into non-calcification group,calcification group and mixed group.All patients were followed up for 1 year.According to presence or absence of major adverse cardiac events(MACE),patients were divided into MACE group and non-MACE group.The pericoronal fat parameters in different groups were compared.The influencing factors of MACE were analyzed by multivariate Logistic regression analysis,and their predictive value for MACE was evaluated by receiver operating characteristic(ROC)curves.Results The pericoronal fat volume and PCATMA in severe group were lower than those in moderate group,while FAI was higher than that in moderate group(P<0.05).There were significant differences in pericoronal fat parameters among patients with different plaque properties(P<0.05).The pericoronal fat volume in calcification group was higher than that in mixed group,PCATMA was higher than that in non-calcification group and mixed group,and FAI was lower than that in non-calcification group and mixed group(P<0.05).The proportions of double-vessel or multi-vessel lesions and severe coronary stenosis,and FAI in MACE group were higher than those in non-MACE group,while PCATMA was lower than that in non-MACE group(P<0.05).Multivariate Logistic analysis showed that severe coronary stenosis and high FAI were independent risk factors of MACE with 1-year follow-up(P<0.05).AUC values of FAI,PCATMA and combined detection for predicting MACE were 0.736(0.634-0.838),0.673(0.572-0.774)and 0.857(0.785-0.930),respectively.AUC of combined detection was greater than that of single index(P<0.05).Conclusion There are different CTA characteristics of pericoronal fat in CHD patients with different coronary stenosis degree and plaque properties.Severe coronary stenosis and high FAI are independent risk factors of MACE with 1-year follow-up.The combined detection of FAI and PCATMA has high predictive value for MACE.